Does Medicare Cover Dexcom G6?

Are you or a loved one living with diabetes and considering a Dexcom G6 Continuous Glucose Monitoring (CGM) system? You may be wondering if Medicare covers the cost of this innovative technology. With over 60 million Americans enrolled in Medicare, it’s important to understand what is and isn’t covered. In this article, we’ll explore the details of Medicare coverage for the Dexcom G6 and provide helpful information to aid in your decision-making process.

Does Medicare Cover Dexcom G6?

What is Dexcom G6?

Dexcom G6 is a continuous glucose monitoring (CGM) system that helps people with diabetes monitor their blood glucose levels in real time. It is a small device that is worn on the skin and uses a tiny sensor to measure glucose levels in the interstitial fluid. The device transmits the glucose data to a receiver or a smartphone app.

Dexcom G6 is a popular choice for people with diabetes because it provides accurate and reliable glucose readings without the need for fingerstick testing. The device is also easy to use and can help people better manage their diabetes.

Medicare Coverage for Dexcom G6

Medicare coverage for Dexcom G6 depends on the type of plan a person has. Medicare Part B covers some diabetes supplies, including glucose monitors and test strips, but it does not cover CGM systems like Dexcom G6.

However, some Medicare Advantage plans may cover the cost of Dexcom G6. These plans are offered by private insurance companies and can provide additional benefits beyond what is covered by Medicare Part A and Part B. People with Medicare Advantage plans should check with their plan provider to see if Dexcom G6 is covered.

It is also important to note that Medicare may cover the cost of Dexcom G6 for people with type 1 diabetes who meet certain criteria. These criteria include frequent hypoglycemia or hyperglycemia, difficulty controlling blood sugar levels, and the need for frequent adjustments to insulin therapy.

Benefits of Dexcom G6

Dexcom G6 offers several benefits for people with diabetes. These benefits include:

1. Real-time glucose monitoring: Dexcom G6 provides continuous glucose readings every five minutes, which can help people better understand their glucose patterns and make adjustments to their diabetes management plan.

2. No fingerstick testing: Dexcom G6 eliminates the need for painful and inconvenient fingerstick testing.

3. Alerts and alarms: Dexcom G6 can alert people when their glucose levels are too high or too low, which can help prevent dangerous hypoglycemia or hyperglycemia.

4. Easy to use: Dexcom G6 is simple to set up and use, which can make managing diabetes less stressful and time-consuming.

Dexcom G6 vs. Other CGM Systems

Dexcom G6 is one of several CGM systems available on the market. Here are some of the key differences between Dexcom G6 and other CGM systems:

1. Freestyle Libre: Freestyle Libre is a flash glucose monitoring system that does not provide continuous glucose readings. Instead, it requires a user to scan a sensor with a smartphone app to get a glucose reading.

2. Medtronic Guardian Connect: Medtronic Guardian Connect is a CGM system that requires a separate transmitter device to send glucose readings to a smartphone app. The device also has a shorter wear time than Dexcom G6.

3. Eversense: Eversense is a CGM system that uses a tiny sensor that is implanted under the skin. The device provides continuous glucose readings for up to 90 days.

While each CGM system has its own advantages and disadvantages, Dexcom G6 is often preferred by people with diabetes because of its ease of use, accuracy, and reliability.

Conclusion

Dexcom G6 is a popular CGM system that can help people with diabetes better manage their condition. While Medicare Part B does not cover the cost of Dexcom G6, some Medicare Advantage plans may provide coverage. It is also possible for people with type 1 diabetes who meet certain criteria to have the cost of Dexcom G6 covered by Medicare.

Regardless of insurance coverage, Dexcom G6 offers several benefits for people with diabetes, including real-time glucose monitoring, no fingerstick testing, alerts and alarms, and ease of use. If you are considering Dexcom G6, talk to your healthcare provider to see if it is right for you.

Frequently Asked Questions

Does Medicare Cover Dexcom G6?

Yes, Medicare covers the Dexcom G6 for beneficiaries who meet certain criteria. The Dexcom G6 is covered under Medicare Part B as a durable medical equipment (DME) item. To be eligible for coverage, you must have a diagnosis of diabetes and meet one of the following criteria:

• You are currently using a blood glucose monitor and have been testing your blood sugar at least four times per day.
• You are currently using a continuous glucose monitoring (CGM) system and have been for at least six months.

If you meet these criteria, your doctor can prescribe the Dexcom G6 and it will be covered by Medicare. Keep in mind that you may still be responsible for paying a portion of the cost, such as deductibles or coinsurance.

What is the process for obtaining a Dexcom G6 through Medicare?

To obtain a Dexcom G6 through Medicare, you must first obtain a prescription from your doctor. Once you have a prescription, you can work with a supplier that participates in the Medicare program to order your device. The supplier will handle the billing and paperwork with Medicare, and you will be responsible for any out-of-pocket costs.

You may also need to provide additional documentation to Medicare, such as proof of your diabetes diagnosis or evidence that you meet the criteria for CGM coverage. Your supplier can assist you with this process.

What costs can I expect to pay for a Dexcom G6 with Medicare?

The cost you will pay for a Dexcom G6 with Medicare will depend on your specific plan and the supplier you choose. You may be responsible for paying a deductible, coinsurance, or copayment for the device. Additionally, if you require additional supplies for your CGM, such as sensors or transmitters, you may also have out-of-pocket costs for those items.

To get a better idea of what your costs will be, it’s best to contact your Medicare plan and supplier directly to discuss pricing and coverage details.

Are there any restrictions on how often I can receive a Dexcom G6 through Medicare?

Medicare does have restrictions on how often you can receive a new Dexcom G6 device. Generally, Medicare will cover a new CGM system every five years, or sooner if the device is lost or no longer functioning properly. Additionally, Medicare will cover up to three CGM sensors per month for beneficiaries who meet the coverage criteria.

If you have any concerns about how often you can receive a new device or supplies, it’s best to speak with your doctor and supplier to understand your options.

Can I use a different CGM system besides the Dexcom G6 with Medicare?

Yes, Medicare covers several different brands and models of CGM systems in addition to the Dexcom G6. However, coverage criteria may vary depending on the specific device. It’s best to speak with your doctor and supplier to determine which CGM system is right for you and whether it is covered by Medicare.

Keep in mind that if you choose a different CGM system, you may need to provide additional documentation to Medicare to demonstrate that you meet the coverage criteria.

In conclusion, Medicare coverage for the Dexcom G6 is a complex issue that requires careful consideration. While the device has been proven to be effective in managing diabetes, there are still many factors to take into account when determining whether it is covered by Medicare.

The good news is that Medicare does cover the Dexcom G6 in some instances, particularly for patients with type 1 diabetes who meet certain criteria. However, it is important to note that coverage may vary depending on the specific plan and circumstances.

Ultimately, if you are a Medicare beneficiary with diabetes and are considering using the Dexcom G6, it is important to do your research and consult with your healthcare provider to determine the best course of action. With the right knowledge and support, you can make informed decisions about your diabetes care and take control of your health and wellbeing.